Ban Yukiko, Abe Masakazu
Department of Cardiovascular Surgery, Ibaraki Children's Hospital, 3-3-1, Futabadai, Mito, Ibaraki, 311-4145, Japan.
Surg Case Rep. 2018 Jun 28;4(1):67. doi: 10.1186/s40792-018-0471-y.
Obstruction of the left main bronchus is a rare but life-threatening complication following the closure of patent ductus arteriosus by surgical clips. We report a successful rescue procedure for this complication in a premature infant.
A 24-week gestational age premature girl weighing 903 g underwent surgical clipping for patent ductus arteriosus at the age of 24 days after birth. Bronchoscopy revealed the left main bronchus obstruction due to the clip compression at 6 h later after the surgery. The patient underwent a rescue re-exploration for this serious complication. New clips were applied to both the intrapericardial and the aortic ends of the patent ductus arteriosus respectively. And then the previous clips, compressing the left main bronchus, were gently removed from the ductus without ductus injury through a re-thoracotomy.
Surgeons should be aware of the possible complication and take care not to place patent ductus arteriosus clips obliquely toward the bronchus.
左主支气管梗阻是手术夹闭动脉导管未闭后一种罕见但危及生命的并发症。我们报告了一例对早产儿该并发症的成功抢救过程。
一名孕24周、体重903克的早产女婴在出生后24天接受了动脉导管未闭手术夹闭。术后6小时支气管镜检查显示左主支气管因夹子压迫而梗阻。针对这一严重并发症，患者接受了抢救性再次探查。分别在动脉导管未闭的心包内端和主动脉端重新应用夹子。然后通过再次开胸，在不损伤动脉导管的情况下，将压迫左主支气管的先前夹子从动脉导管上轻柔移除。
外科医生应意识到可能出现的并发症，注意避免将动脉导管未闭夹斜向支气管放置。
